The American Civil War was a devastating conflict that pushed the boundaries of medical science and practices in the midst of carnage and casualty. During this period of time in history, the practice of antisepsis and prevention of infection emerged as an important aspect of medical care for wounded soldiers. Although the war was fought in America, the medical practices were influenced by the greater international community, particularly from Europe. This paper will delve into the European influences that lead to advancements in the field of antiseptic science during the Civil War period and beyond.
Louis Pasteur (1822-1895) was a French scientist whose work revealed that microorganisms were the cause of both fermentation and disease. His work on the study of fermentation began while he was working at the University of Lille, studying problems related to alcohol production at a local distillery. This investigation led by Pasteur introduced new ideas related to microbiology, for instance the fermentation of butyric acid. Eventually, in 1857, he presented evidence that specific organisms were responsible for different kinds of fermentation. This concept laid the groundwork for what is known as germ theory.
Joseph Lister (1827 -1912), known as the “father of modern surgery”, was an English surgeon best known for his contributions to founding the concept of antiseptic surgery. Before Lister’s time, suppurative, infected wounds were thought to be an expected stage of wound healing. Building upon the work of Louis Pasteur, Lister proposed that the same process driving microbial fermentation was involved with the septic transformation of surgical wounds. He tested this hypothesis using carbolic acid on compound fracture wounds, which was highly successful in preventing sepsis and gangrene. Lister’s discovery of carbolic acid, and the principle of his discovery, shaped the way sepsis was prevented during the civil war period and beyond.
“The hospitals, with their festering sores, putrid wounds, were enough to fix certain odors forever” - Walt Whitman once said to describe the scene and smells of Civil War hospitals. Whitman later discovered that this smell was not due to the decomposing flesh wounds, but rather the strong scent of the carbolic acid used by the physicians to treat the wounds. Controversy ensued over the use of antiseptic disinfectants - previously the American paradigm was to fight foul odors with fresh air and pleasant fragrances to counteract the odor from infection. The abnormal smell induced skepticism and opposition to the use of such disinfectants. Nevertheless, the influence of Joseph Lister was felt and carbolic acid was used, although not frequently and not in a controlled manner, as an antiseptic by Civil War physicians.
Ignac Semmelweis (1818-1865) was a Hungarian obstetrician who was considered to be the “father of handwashing”. Before his time, childbed fever was a significant public health threat and major contributor to maternal mortality during childbirth. Much like the surgical infections questioned by Joseph Lister, childbed fever was commonly thought to be due to “miasma” or unhealthy smell/vapor. Semmelweis initially hypothesized that certain “death particles” from bodies and tissues stuck to the hands of physicians and were responsible for the high incidence of childbed fever. He tested this hypothesis and established a strong, temporal relationship between handwashing practices and a lower mortality rate due to childbed fever. Once again, this notion was met with great skepticism by the medical institution and society at large. The criticism was so strong that Semmelweis ended up in a mental asylum after suffering terrible bouts of depression and paranoia.
Despite the unfortunate ending to the story of Ignac Semmelweis, his efforts and discoveries about hand hygiene did have an influence on Civil War medicine, albeit mainly indirectly. His work contributed to germ theory, which had an increasingly important impact as the war went on. As the acceptance of germ theory emerged and civil war medical personnel became more aware of its relevance, sanitation and hand hygiene became more of a priority and Semmelweis’ work helped shape antisepsis precautions during the war.
In summary, the influences of European physicians and scientists on antisepsis efforts and techniques during the civil war were fairly significant. The ideas from Pasteur related to germ theory, ideas from Lister related to antiseptic wound care, and ideas from Semmelweis related to hand hygiene all contributed to reductions in infection related complications amongst Civil War soldiers, particularly as the war progressed. The exchange of medical information and knowledge between Europe and the United States proved to have a large impact on the changes to antisepsis efforts throughout the war and the development of medical practices today. The Civil War, in some ways, represented a demand for answers given the high mortality rates due to infection.
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Sources:
Pitt D, Aubin JM. Joseph Lister: father of modern surgery. Can J Surg. 2012 Oct;55(5):E8-9. doi: 10.1503/cjs.007112. PMID: 22992425; PMCID: PMC3468637.
Tyagi U, Barwal KC. Ignac Semmelweis-Father of Hand Hygiene. Indian J Surg. 2020 Jun;82(3):276-277. doi: 10.1007/s12262-020-02386-6. Epub 2020 May 21. PMID: 32837058; PMCID: PMC7240806.
https://www.britannica.com/biography/Louis-Pasteur/Vaccine-development
https://www.civilwarmed.org/disinfection/
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